Abstract
BackgroundAlthough viruses are known to be the second most common etiological factor in community-acquired pneumonia (CAP), the respiratory viral profile of the patients with healthcare-associated pneumonia (HCAP) has not yet been elucidated. We investigated the prevalence and the clinical impact of respiratory virus infection in adult patients with HCAP.MethodsPatients admitted with HCAP or CAP, between January and December 2016, to a tertiary referral hospital in Korea, were prospectively enrolled, and virus identification was performed using reverse-transcription polymerase chain reaction (RT-PCR).ResultsAmong 452 enrolled patients (224 with HCAP, 228 with CAP), samples for respiratory viruses were collected from sputum or endotracheal aspirate in 430 (95.1%) patients and from nasopharyngeal specimens in 22 (4.9%) patients. Eighty-seven (19.2%) patients had a viral infection, and the proportion of those with viral infection was significantly lower in the HCAP than in the CAP group (13.8% vs 24.6%, p = 0.004). In both the HCAP and CAP groups, influenza A was the most common respiratory virus, followed by entero-rhinovirus. The seasonal distributions of respiratory viruses were also similar in both groups. In the HCAP group, the viral infection resulted in a similar length of hospital stay and in-hospital mortality as viral–bacterial coinfection and bacterial infection, and the CAP group showed similar results.ConclusionsThe prevalence of viral infection in patients with HCAP was lower than that in patients with CAP, and resulted in a similar prognosis as viral–bacterial coinfection or bacterial infection.
Highlights
Patients increasingly receive treatment at facilities other than hospitals, including long-term health care facilities, due to the rapidly increasing aged population, who more often have chronic diseases [1, 2] Pneumonia occurring prior to hospital admission in patients who have had recent contact with health systems is termed healthcare-associated pneumonia (HCAP) [3,4,5]
Eighty-seven (19.2%) patients had a viral infection, and the proportion of those with viral infection was significantly lower in the HCAP than in the community-acquired pneumonia (CAP) group (13.8% vs 24.6%, p = 0.004)
In the HCAP group, the viral infection resulted in a similar length of hospital stay and in-hospital mortality as viral–bacterial coinfection and bacterial infection, and the CAP group showed similar results
Summary
Patients increasingly receive treatment at facilities other than hospitals, including long-term health care facilities, due to the rapidly increasing aged population, who more often have chronic diseases [1, 2] Pneumonia occurring prior to hospital admission in patients who have had recent contact with health systems is termed healthcare-associated pneumonia (HCAP) [3,4,5]. These patients are believed to be at increased risk for infection with multidrug-resistant (MDR) organisms [3, 4], and is of particular concern in HCAP patients. Its clinical implications are debatable, because most studies performed PCR using nasopharyngeal or oropharyngeal swabs [22], which might yield a negative result in patients with lower respiratory tract viral infection [11, 23]
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